Fish Oil Medicine

October 30, 2013 Written by JP    [Font too small?]

One of the strengths of evidence-based, natural medicine is confidence. As a consultant, educator and writer, I have confidence about my positions because they’re backed by peer-reviewed, scientific evidence. Therefore, I’m not just one lonely voice making an impassioned argument. Rather, I’m part of a collective of voices that uses documented facts and findings to further the cause of natural health care. This very same philosophy can be used by individuals who have no particular interest in working in the field of medicine. In fact, it can work equally well for anyone who simply wishes to incorporate more natural remedies into their treatment program.

The odds of a conventional doctor supporting the use of natural remedies goes up or down based on how you present your case. One of the best ways to get your physician to work with you when wishing to use a natural supplement is to provide her or him with evidence that is difficult to dismiss. For instance, bringing a print out of one or more scientific studies that establishes the efficacy and safety of a given therapy is very helpful. Below, are five examples of studies that prove that fish oil supplementation can be used safely alongside conventional treatments for a variety of conditions. What’s more, the health benefits and/or the mitigation of medication-induced side effects is also described in each trial.

Study #1: Taking 1.2 grams/day of fish oil for 12 weeks resulted in improvements in psychosocial functioning and a reduction in psychopathology in a group of fifteen adolescents diagnosed with borderline personality disorder.

Study #2: 5.5 grams daily of DHA and EPA (fish oil) dramatically increased remission rates in patients receiving drug treatment for rheumatoid arthritis.

Study #3: The addition of fish oil to a liquid diet given to elderly diabetics caused meaningful declines in fasting blood sugar, HbA1c (a measure of long term blood sugar) and apolipoprotein B (a risk factor for heart disease).

Study #4: Taking 2 grams/day of fish oil for 9 weeks lowers inflammatory markers and protects against unwanted weight loss in patients undergoing chemotherapy for colorectal cancer.

Study #5: Supplementing with 4 grams daily of fish oil in combination with interferon therapy is “highly effective” in addressing chronic inflammation and oxidative stress in adults living with relapsing-remitting multiple sclerosis.

One final piece of advice: a few of the study links below provide free access to the full texts of the papers I cited today. The remainder offers only abstracts or summaries of the trials. Please note that presenting your physicians with the full text is always preferable to the abstract. If a free version of the complete text of a study isn’t available, you can always purchase it from the publisher. The price varies from journal to journal, but is typically less than $50. Another option is to call or email one of the authors of the study itself. Contact information usually appears at the beginning of a paper or can be found by searching the Internet. Many times, researchers are more than happy to send complementary copies of the full text of their studies to interested parties.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 – Omega-3 Fatty Acid Supplementation in Adolescents with Borderline (link)

Study 2 – Fish Oil in Recent Onset Rheumatoid Arthritis: A Randomised, Double- (link)

Study 3 – Eicosapentaenoic Acid Improves Glycemic Control in Elderly Bedridden … (link)

Study 4 – Fish Oil Decreases C-Reactive Protein/Albumin Ratio Improving … (link)

Study 5 – Efficacy of Fish Oil on Serum of TNF α , IL-1 β , and IL-6 Oxidative Stress (link)

Fish Oil Supplementation May Reduce Cancer Treatment Side Effects

Eur J Clin Nutr. 2012 Mar;66(3):399-404. (link)

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Posted in Alternative Therapies, Bone and Joint Health, Nutritional Supplements

21 Comments & Updates to “Fish Oil Medicine”

  1. Ted Hutchinson Says:

    Those who feel medical, nutritional research shouldn’t be hidden permanently behind paywalls, may want to join this campaign to highlight the extent of the problem. Open Access Button

  2. JP Says:

    What an excellent resource! Thank you, Ted!

    Be well!


  3. JP Says:

    Update: Fish oil may promote the repair of damaged blood vessels …

    Fish-oil supplementation alters numbers of circulating endothelial progenitor cells and microparticles independently of eNOS genotype1,2,3,4

    Background: Emerging cellular markers of endothelial damage and repair include endothelial microparticles (EMPs) and endothelial progenitor cells (EPCs), respectively. Effects of long-chain (LC) n−3 (omega-3) polyunsaturated fatty acids (PUFAs) and the influence of genetic background on these markers are not known.

    Objective: We investigated effects of fish-oil supplementation on both classical and novel markers of endothelial function in subjects prospectively genotyped for the Asp298 endothelial nitric oxide synthase (eNOS) polymorphism and at moderate risk of cardiovascular disease (CVD).

    Design: A total of 84 subjects with moderate risk of CVD (GG: n = 40; GT/TT: n = 44) completed a randomized, double-blind, placebo-controlled, 8-wk crossover trial of fish-oil supplementation that provided 1.5 g LC n−3 PUFAs/d. Effects of genotype and fish-oil supplementation on the blood lipid profile, inflammatory markers, vascular function (by using peripheral artery tonometry), and numbers of circulating EPCs and EMPs (by using flow cytometry) were assessed.

    Results: There was no significant effect of fish-oil supplementation on blood pressure, plasma lipids, or plasma glucose, although there was a trend (P = 0.069) toward a decrease in the plasma triglyceride concentration after fish-oil supplementation compared with placebo treatment. GT/TT subjects tended to have higher concentrations of total cholesterol and low-density lipoprotein cholesterol, but vascular function was not affected by either treatment or eNOS genotype. Biochemical markers of endothelial function were also unaffected by treatment and eNOS genotype. In contrast, there was a significant effect of fish-oil supplementation on cellular markers of endothelial function. Fish-oil supplementation increased numbers of EPCs and reduced numbers of EMPs relative to those with placebo treatment, which potentially favored the maintenance of endothelial integrity. There was no influence of genotype for any cellular markers of endothelial function, which indicated that effects of fish-oil supplementation were independent of eNOS genotype.

    Conclusion: Emerging cellular markers of endothelial damage, integrity, and repair appear to be sensitive to potentially beneficial modification by dietary n−3 PUFAs.

    More Info:

    Be well!


  4. JP Says:

    Update: Fish oil may reduce damage caused by heart attack …

    “WEDNESDAY, March 4, 2015 (HealthDay News) — High doses of omega-3 fatty acids may protect against further damage in heart attack patients, a preliminary study suggests.

    The research included 374 heart attack survivors who received standard treatment and took either a 4-gram prescription-only dose of omega-3 fatty acids each day or a placebo. The researchers said that people probably couldn’t get that level of omega-3 fatty acids from diet alone. To illustrate how large a dose that is, the researchers noted that 4 grams of omega-3 fatty acids is the equivalent of eating 8 ounces of salmon.

    Using MRIs, the patients’ hearts were scanned two weeks, four weeks and six months after their heart attack.

    Compared to those taking the placebo, patients taking the omega-3 capsules had lower levels of inflammation and were 39 percent less likely to show deterioration of heart function. There was also less thickening or scarring of the areas of the heart that were not directly damaged during the heart attack. This thickening, also known as fibrosis, often develops when the surviving heart muscle works harder to compensate for the damaged tissue, according to the researchers.”

    Be well!


  5. JP Says:

    Updated 05/17/16:

    Prostaglandins Leukot Essent Fatty Acids. 2016 May;108:45-50.

    The clinical benefits of long-term supplementation with omega-3 fatty acids in cystic fibrosis patients – A pilot study.

    Effectiveness of omega-3 supplementation in cystic fibrosis (CF) remains controversial. This study sought to evaluate clinical status, exercise tolerance, inflammatory parameters, and erythrocyte fatty acid profile after 1 year of oral omega-3 supplementation in CF patients. Fifteen ΔF508-homozygous patients undergoing chronic azithromycin were randomized to receive omega-3 fish oil supplementation at a dose of 60mg/Kg/day or placebo. In comparison with the previous year, in the supplemented group, the number of pulmonary exacerbations decreased at 12 months (1.7 vs. 3.0, p<0.01), as did the duration of antibiotic therapy (26.5 days vs. 60.0 days, p<0.025). Supplementation significantly increased the levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) as early as <3 months of administration, with concomitant decreases in arachidonic acid (AA) levels. This pilot study suggests that long-term omega-3 supplementation offers several clinical benefits as to the number of exacerbations and duration of antibiotic therapy in CF patients.

    Be well!


  6. JP Says:

    Updated 06/26/16:

    Biomark Res. 2016 Jun 23;4:13.

    The effect of n-3 polyunsaturated fatty acids on incidence and severity of oxaliplatin induced peripheral neuropathy: a randomized controlled trial.

    BACKGROUND: Oxaliplatin induced peripheral neurotoxicity (OXIPN) is the major dose-limiting and long-lasting side effect of oxaliplatin. N-3 PUFAs have neuroprotective property via their effects on voltage-gated ion channels and by reducing the production of proinflammatory cytokines that causes neuropathy. This study was a randomized double blind placebo controlled trial to find the possible advantages of n-3 PUFAs for preventing and reducing the severity of OXIPN in patients with colon cancer.

    METHODS: Eligible patients with colon cancer randomly allocated to take n-3 PUFAs pearls, 640 mg t.i.d during chemotherapy with oxaliplatin and one month after the cessation of the treatment or placebo. All patients were evaluated for incidence and severity of OXIPN based on “reduced Total Neuropathy Score” in which clinical and electrophysiological assessments were included.

    RESULTS: Seventeen patients (47 %) of the n-3 PUFA supplemented group (n = 36) did not develop PN while it was 11 %(4 patients) in the placebo group (n = 35). There was a significant difference in PN incidence (OR = 0.14, .95 % CI = (0.04 to 0.49), p = 0.002). The difference of OXIPN severity was significant between the two study groups (B = -1.61, 0.95 % CI = (-2.59 to -0.62), p = 0.001).

    CONCLUSIONS: N-3 PUFAs may have neuroprotective effect for reducing the incidence and severity of OXIPN. Finding an effective prophylactic or symptomatic therapy for OXIPN would significantly improve the patients’ quality of life.

    Be well!


  7. JP Says:

    Updated 10/17/16:

    Plasma eicosapentaenoic acid is negatively associated with all-cause mortality among men and women in a population-based prospective study

    Omega-3 polyunsaturated fatty acids (PUFA) have anti-inflammatory properties while omega-6 PUFAs appear to have pro-inflammatory properties. We aimed to assess plasma omega-3 and omega-6 PUFA status in relation to all-cause mortality in an Australian community-based study. We hypothesized that omega-3 PUFA would be inversely associated, and omega-6 PUFA positively associated with all-cause mortality. Plasma phospholipid omega-3 (eicosapentaenoic acid (EPA), docosapentaenoeic acid (DPA), docosahexaenoic acid, α-linolenic acid, and total) and omega-6 PUFAs (linoleic acid, arachidonic acid, and total) were measured among 1008 adults (44% men) in 1996. Plasma PUFA composition was quantified using gas chromatography. During 17-years’ follow-up, 98 men and 81 women died. After adjustment for potential confounding factors, plasma EPA was inversely associated with all-cause mortality overall (adjusted hazard ratio (HR) per 1-standard deviation increase 0.81, 95% confidence interval (CI) 0.68–0.95), in men (HR 0.78, 95% CI 0.62–0.98) and women (HR 0.78, 95% CI 0.65–0.94) separately. Inverse associations with mortality among men were also seen for DPA (HR 0.76, 95% CI 0.60–0.97) and α-linolenic acid (HR 0.73, 95% CI 0.57–0.94). No omega-6 PUFAs were significantly associated with mortality. Our findings of reduced all-cause mortality in men and women who have high EPA in plasma, and in men with high plasma DPA and α-linolenic acid, partially support our hypothesis that omega-3 PUFAs help reduce mortality but provide no evidence that omega-6 PUFAs may increase mortality.

    Be well!


  8. JP Says:

    Updated 10/29/16:

    Brain Behav Immun. 2016 Oct 11.

    Oxidative stress predicts depressive symptom changes with omega-3 fatty acid treatment in coronary artery disease patients.

    BACKGROUND: Antidepressant efficacy of omega-3 polyunsaturated fatty acid (n-3 PUFA) treatment in coronary artery disease (CAD) patients remains unpredictable. N-3 PUFA can mitigate oxidative stress, which is common in CAD and may contribute to depressive symptoms. This study investigated whether greater pre-treatment oxidative stress, measured by the ratios of late-stage lipid peroxidation markers (malondialdehyde [MDA], 4-hydroxy-2-nonenal [4-HNE], and 8-isoprostane [8-ISO]) to an early-stage marker (lipid hydroperoxides [LPH]), predicted n-3 PUFA antidepressant benefits in CAD.

    METHODS: This was a secondary analysis of CAROTID (CAD Randomized Omega-3 Trial in Depression, NCT00981383). Patient demographics and medical characteristics were collected. Depressive symptoms were measured using the 17-item Hamilton Depression Rating Scale (HAM-D). Patients were then randomized to receive either 1.9g/day n-3 PUFA or placebo for 12weeks, after which HAM-D scores were reassessed. Baseline LPH, 4-HNE, 8-ISO, MDA and n-3 PUFA concentrations were analysed from fasting blood.

    RESULTS: Seventy-nine patients (age=61.1±8.5, 76% male, HAM-D=7.5±6.1) were included (n=45 placebo, n=34 n-3 PUFA). In the n-3 PUFA group, higher baseline ratios of MDA/LPH (primary analysis: F1,33=6.20, beta=-0.35, p=0.018), 4-HNE/LPH (exploratory analysis: F1,33=5.35, beta=-0.32, p=0.027), and 8-ISO/LPH (exploratory analysis: F1,33=6.10, beta=-0.33, p=0.019), indicating higher oxidative stress, were associated with greater depressive symptom improvement. In each model, higher baseline EPA+DHA concentrations independently predicted depressive symptom improvement with n-3 PUFA (MDA/LPH: F1,33=11.05, p=0.002; 4-HNE/LPH: F1,33=11.36, p=0.002; 8-ISO/LPH: F1,33=13.15, p=0.001). No associations were observed in the placebo group.

    CONCLUSIONS: n-3 PUFA may be more likely to improve depressive symptoms in CAD patients with pre-treatment evidence of oxidative stress.

    Be well!


  9. JP Says:

    Updated 01/19/17:

    Clinical Nutrition – Published online: January 14, 2017

    Effect of omega 3 polyunsaturated fatty acids derived from fish oil in major burn patients: A prospective randomized controlled pilot trial

    Background & aims: The burn patient is the clearest example of prolonged inflammatory response. Various nutrients, particularly omega-3 polyunsaturated fatty acids (ω-3 PUFAs), have been demonstrated as attenuating the inflammatory response, and reduce infectious complications. In absence of definitive evidence in major burns the study aimed at investigating the effect particularly on infectious complications of enteral nutrition enriched with ω-3 PUFAs.

    Method: Prospectively randomized controlled trial. Inclusion criteria: adult patients admitted to intensive care (ICU), burns > 15% body surface area (BSA), with inhalation injury requiring mechanical ventilation for ≥ 6 days and enteral nutrition. Intervention: low-fat (18% energy as fat) modular diet (LF-EN) or identical with 50% of fat as fish oil (FO-EN). Study endpoints: infectious and other complications, length of mechanical ventilation time, mortality.

    Results: Altogether 92 patients, aged 40 years old and burned 38% BSA were analyzed (45 patients in LF-EN and 47 in FO-EN). Baseline characteristics were similar. Severe sepsis and septic shock together were significantly fewer in FO-EN group, 15% versus 33%, p = 0.03, (others infections unchanged). Non-infectious complications were less frequent in group FO-EN, with a significant reduction of high gastric residual volume (33% versus 8.5%: p = 0.003). Mechanical ventilation was non-significantly shorter with FO-EN (22 versus 26 days). Mortality did not differ.

    Conclusion: The inclusion of ω-3 PUFAs in a low fat diet in ICU burned patients was associated with significant clinical benefits compared to a conventional low fat diet, with lower rates of severe sepsis, septic shock and pyloric dysfunction.

    Be well!


  10. JP Says:

    Updated 04/05/17:

    J Hum Nutr Diet. 2017 Apr 4.

    Oral fish oil positively influences nutritional-inflammatory risk in patients with haematological malignancies during chemotherapy with an impact on long-term survival: a randomised clinical trial.

    BACKGROUND: Studies suggest that the ingestion of fish oil (FO), a source of the omega-3 polyunsaturated fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), can reduce the deleterious side-effects of chemotherapy. The aim of this randomised clinical trial was to evaluate the effect of supplementation with oral FO for 9 weeks on nutritional parameters and inflammatory nutritional risk in patients with haematological malignancies during the beginning of chemotherapy.

    METHODS: Twenty-two patients with leukaemia or lymphoma were randomised to the unsupplemented group (UG) (n = 13) or supplemented group (SG) (n = 9). SG received 2 g/day of fish oil for 9 weeks. Nutritional status, serum acute-phase proteins and plasma fatty acids were evaluated before (T0) and after (T1) the intervention period. Data were analysed using two models; model 1, comprising data from all patients included in the study, and model 2, comprising data from UG patients with no increase in the proportions of EPA and DHA in plasma and data from SG patients showing an at least 100% increase in plasma EPA and DHA.

    RESULTS: SG showed an increased plasma proportion of EPA and DHA in both models. In model 2, C-reactive protein (CRP) and CRP/albumin ratio showed larger reductions in the SG. Overall long-term survival in both models (465 days after the start of the chemotherapy) was higher in the group ingesting fish oil (P < 0.05).

    CONCLUSIONS: These findings indicate an improved nutritional-inflammatory risk and potential effects on long-term survival in patients with haematological malignancies supplemented with FO during the beginning of chemotherapy.

    Be well!


  11. JP Says:

    Updated 04/16/17:

    Cardiovasc Diabetol. 2017 Apr 14;16(1):50.

    Treatment with high-dose n-3 PUFAs has no effect on platelet function, coagulation, metabolic status or inflammation in patients with atherosclerosis and type 2 diabetes.

    BACKGROUND: Despite numerous studies on cardioprotective effects of omega-3 polyunsaturated fatty acids (n-3 PUFAs), there is limited evidence for n-3 PUFA-mediated effects, especially at its higher dose, on cardiovascular risk in patients with type 2 diabetes (DM2) and established atherosclerosis.

    PURPOSE: To investigate the effect of daily treatment with a higher dose (2 g) of n-3 PUFAs on platelet function, coagulation parameters, fibrin clot properties, markers of systemic inflammation and metabolic status, in patients with atherosclerotic vascular disease and DM2 who receive optimal medical therapy.

    METHODS: We conducted a prospective, double-blind, placebo-controlled, randomized, double-center study, in which thrombin generation (plasma thrombogenic potential from automated thrombogram), fibrin clot properties (plasma fibrin clot permeability; lysis time), platelet aggregation (light transmission aggregometry with adenosine diphosphate and arachidonic acid used as agonists), HbA1c, insulin level, lipid profiles, leptin and adiponectin levels, as well as markers of systemic inflammation (i.e., hsCRP, IL-6, TNF-α, ICAM-1, VCAM-1, and myeloperoxidase) were determined at baseline and at 3 months after treatment with 2 g/day of n-3 PUFAs (n = 36) or placebo (n = 38). Moreover, we assessed serum fatty acids of the phospholipid fraction by gas chromatography both at baseline and at the end of the study.

    RESULTS: Majority of patients were treated with optimal medical therapy and achieved recommended treatment targets. Despite higher serum levels of eicosapentaenoic acid (EPA) (by 204%; p < 0.001) and docosahexaenoic acid (DHA) (by 62%; p < 0.0001) in n-3 PUFA group at the end of treatment no changes in platelet aggregation, thrombin generation, fibrin clot properties or markers of systemic inflammation were observed. No intergroup differences in the insulin, HbA1c and lipid levels were found at the end of the study. There was no change in adiponectin and leptin in interventional group, however leptin increased in control group (p = 0.01), therefore after study period leptin levels were lower in the interventional group (p = 0.01). Additionally, resolvin D1 did not differ between interventional and control group. CONCLUSIONS: In conclusion, our study demonstrated that in patients with long-standing, well-controlled DM2 and atherosclerotic disease the treatment with a high dose of n-3 PUFAs (namely, 1 g/day of EPA and 1 g/day of DHA for 3 months) does not improve coagulation, metabolic, and inflammatory status when measured with the specified tests. Be well! JP

  12. JP Says:

    Updated 07/01/17:

    Br J Nutr. 2017 May 31:1-8.

    High-quality fish oil has a more favourable effect than oxidised fish oil on intermediate-density lipoprotein and LDL subclasses: a randomised controlled trial.

    Fish oil (FO) supplementation reduces the risk of CVD. However, it is not known if FO of different qualities have different effects on lipoprotein subclasses in humans. We aimed at investigating the effects of oxidised FO and high-quality FO supplementation on lipoprotein subclasses and their lipid concentrations in healthy humans. In all, fifty-four subjects completed a double-blind randomised controlled intervention study. The subjects were randomly assigned to receive high-quality FO (n 17), oxidised FO (n 18) or high-oleic sunflower oil capsules (HOSO, n 19) for 7 weeks. The concentration of marine n-3 fatty acids was equal in high-quality FO and oxidised FO (1·6 g EPA+DHA/d). The peroxide value (PV) and anisidine value (AV) were 4 mEq/kg and 3 in high-quality FO and HOSO, whereas the PV and AV in the oxidised FO were 18 mEq/kg and 9. Blood samples were collected at baseline and end of study. NMR spectroscopy was applied for the analysis of lipoprotein subclasses and their lipid concentrations. High-quality FO reduced the concentration of intermediate-density lipoprotein (IDL) particles and large, medium and small LDL particles, as well as the concentrations of total lipids, phospholipids, total cholesterol, cholesteryl esters and free cholesterol in IDL and LDL subclasses compared with oxidised FO and HOSO. Hence, high-quality FO and oxidised FO differently affect lipid composition in lipoprotein subclasses, with a more favourable effect mediated by high-quality FO. In future trials, reporting the oxidation levels of FO would be useful.

    Be well!


  13. JP Says:

    Updated 06/06/17:

    Nutrients 2017, 9(6), 573

    Effect of n-3 Polyunsaturated Fatty Acid Supplementation on Metabolic and Inflammatory Biomarkers in Type 2 Diabetes Mellitus Patients

    Background: Type 2 diabetes mellitus (T2DM) is accompanied by chronic low-grade inflammation, with an imbalance in the secretion of adipokines and, worsening insulin resistance. Supplementation with n-3 PUFA in T2DM decreases inflammatory markers, the purpose of the study was to investigate the effect of n-3 PUFA supplementation on adipokines, metabolic control, and lipid profile in T2DM Mexican adults. Methods: In a randomized, single-blind, placebo-controlled pilot study, 54 patients with T2DM received 520 mg of DHA + EPA-enriched fish-oil (FOG) or a placebo (PG) daily. Baseline and 24-week anthropometric and biochemical measurements included glucose, insulin, glycosylated hemoglobin (Hb1Ac), leptin, adiponectin, resistin, and lipid profile; n-3 PUFA intake was calculated in g/day. Results: Waist circumference and blood glucose showed significant reductions in the FOG group (p = 0.001 and p = 0.011, respectively). Hb1Ac (p = 0.009 and p = 0.004), leptin (p < 0.000 and p < 0.000), and leptin/adiponectin ratio (p < 0.000 and p < 0.000) decreased significantly in both groups after 24 weeks (FOG and PG respectively). Serum resistin (FOG p < 0.000 and PG p = 0.001), insulin (FOG p < 0.000 and PG p < 0.000), and HOMA-IR (FOG p = 0.000 and PG p < 0.000) increased significantly in both groups. FOG had an overall improvement in the lipid profile with a significant decrease in triacylgycerols (p = 0.002) and atherogenic index (p = 0.031); in contrast, the PG group had increased total cholesterol (p < 0.000), non-HDL cholesterol (p < 0.000), and atherogenic index (p = 0.017). Conclusions: We found a beneficial effect of n-3 PUFA supplementation on waist circumference, glucose, Hb1Ac, leptin, leptin/adiponectin ratio, and lipid profile, without significant changes in adiponectin, and increases in resistin, insulin, and HOMA-IR in both groups. Be well! JP

  14. JP Says:

    Updated 12/21/17:

    Nutr Diabetes. 2017 Dec 19;7(12):1.

    Comparison of the effect of omega-3 supplements and fresh fish on lipid profile: a randomized, open-labeled trial.

    BACKGROUND: Dietary fish is a rich source of Omega-3 poly-unsaturated fatty acids (PUFAs). These compounds may have protective effect against cardiovascular events possibly by modifying lipid profiles. Consequently, fish oil supplements are produced commercially to complement low fish intake. It is not clear if both interventions have similar effects. The aim of this trial was to compare the anti-hyperlipidemic effect of omega3 fatty acid supplements with fresh fish.

    METHOD: A total of 106 patients with hyperlipidemia were randomized. One group received 2 g/day of omega-3 capsules for a period of 8 weeks and the other group received a mean of 250 g trout fish twice weekly (for dinner and lunch) for the same time period. The effects of these diets on the lipid profile after the intervention were compared between the two groups.

    RESULTS: Data from 48 patients in fish oil group and 47 patients from fish group was used for final analysis. In both groups, total cholesterol, non-HDL cholesterol, triglyceride (TG) levels, and Castelli I index (total cholesterol/HDL ratio) were reduced significantly following the treatment; however, dietary-fish intake had a more pronounced effect (-85.08 ± 74.82 vs. -30.75 ± 89.00, P < 0.001; 75.06 ± 35.43 vs. -16.93 ± 40.21, P < 0.001; -66.55 ± 30.79 vs. -12.7 ± 35.48, P = 0.003; and -0.77 ± 1.39 vs. -3.02 ± 1.85, P < 0.001; respectively). HDL level was increased in both groups with a higher effect in dietary fish group (4.47 ± 7.83 vs. 8.51 ± 8.79, P = 0.022). Atherogenic (Log [TG/HDL ratio]) and Castelli II (LDL/HDL ratio) indices did not change in fish oil group while were reduced significantly by fresh fish consumption (-0.04 ± 0.27 vs. -0.26 ± 0.17, P < 0.001; and 0.15 ± 0.7 vs. -1.32 ± 1.15, P < 0.001, respectively). LDL level was increased in the supplementation group, while it was significantly reduced in the dietary-fish group (+18.7 ± 24.97 vs. -22.75 ± 27.28, P < 0.001). CONCLUSION: Consumption of fresh fish seems to be superior in positively modifying the lipid profiles which may have important translations in the occurrence of cardiovascular events. Be well! JP

  15. JP Says:

    Updated 1/12/18:

    Allergy. 2018 Jan 10.

    Fish oil in infancy protects against food allergy in Iceland – results from a birth cohort study.

    BACKGROUND: Consumption of oily fish or fish oil during pregnancy, lactation, and infancy has been linked to a reduction in the development of allergic diseases in childhood.

    METHODS: In an observational study, Icelandic children (n = 1304) were prospectively followed from birth to 2.5 years with detailed questionnaires administered at birth and at one and two years of age, including questions about fish oil supplementation. Children with suspected food allergy were invited for physical examinations, allergic sensitization tests, and a double-blind, placebo-controlled food challenge if the allergy testing or clinical history indicated food allergy. The study investigated the development of sensitization to food and confirmed food allergy according to age and frequency of postnatal fish oil supplementation using proportional hazards modelling.

    RESULTS: The incidence of diagnosed food sensitization was significantly lower in children who received regular fish oil supplementation (relative risk 0.51, 95% confidence interval 0.32-0.82). The incidence of challenge-confirmed food allergy was also reduced, although not statistically significantly (0.57, 0.30-1.12). Children who began to receive fish oil in their first half year of life were significantly more protected than those who began later (p = 0.045 for sensitization, p = 0.018 for allergy). Indicators of allergy severity decreased with increased fish oil consumption (p = 0.013). Adjusting for parent education and allergic family history did not change the results.

    CONCLUSION: Postnatal fish oil consumption is associated with decreased food sensitization and food allergies in infants and may provide an intervention strategy for allergy prevention.

    Be well!


  16. JP Says:

    Updated 2/2/18:

    Asia Pac J Clin Nutr. 2018;27(2):306-312.

    The efficacy of parenteral fish oil in critical illness patients with sepsis: a prospective, non-randomized, observational study.

    BACKGROUND AND OBJECTIVES: To investigate the clinical outcomes in septic patients receiving parenteral fish oil.

    METHODS AND STUDY DESIGN: A prospective, non-randomized, observational clinical study was carried out in 112 patients with sepsis from March, 2013 to May, 2015 in the surgical intensive care unit (SICU) of a tertiaryreferral hospital. The patients were put into one of two groups; either the control or the study group. Patients received the standard treatment of sepsis based on guidelines in the control group. In the study group, patients received parenteral nutrition (PN) containing fish oil. The Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, the length of ICU and hospital stay, duration of mechanical ventilation, mortality, and readmission into the ICU were recorded. Tumor necrosis factor (TNF)-α and procalcitonin (PCT) levels were also evaluated.

    RESULTS: The study group showed a significant reduction for all-cause mortality (20.0% vs 10.0% in study and control groups, p=0.034) and APACHE II score on day 5 (p=0.015), day 7 (p=0.036) and day out of SICU (p=0.045) compared with the control group. The study group tended to show a shortened length of stay in the ICU compared to the control group. However, TNF-α and PCT level, 28 d mortality, the length of hospital stay and the duration of mechanical ventilation did not show statistical differences between the two groups. There were no drug-related adverse effects shown during the study.

    CONCLUSIONS: PN with fish oil is probably safe and may improve clinical outcome in critical ill patients with sepsis.

    Be well!


  17. JP Says:

    Updated 08/19/18:

    JACC Heart Fail. 2018 Aug 7.

    Long-Chain Omega-3 Fatty Acid Supplements in Depressed Heart Failure Patients: Results of the OCEAN Trial.

    OBJECTIVES: The goal of this study was to test the effects of long-chain omega-3 fatty acid supplementation on omega-3 levels, depressive symptoms, and other psychosocial factors, as well as other chronic heart failure (CHF)-related functional measures.

    BACKGROUND: Patients with CHF and depression had low blood omega-3 concentrations that were associated with an elevated risk of mortality.

    METHODS: This study was a randomized, double-blind, placebo-controlled pilot clinical trial using a 400/200 eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA) fish oil at 2 g and an almost pure EPA at 2 g, compared with a matched placebo, daily for 12 weeks for patients with CHF and major depressive disorder. Statistical analyses included the intention-to-treat population and “completers” (defined as participants consuming ≥70% of the capsules and completing the final endpoint evaluation between 10 and 14 weeks).

    RESULTS: A total of 108 patients with CHF and major depressive disorder and a score ≥18 on the Hamilton Depression Scale who were randomized at 1:1:1 to the 3 interventions at 3 enrolling centers from June 12, 2014, to May 19, 2016; 80 (74.1%) qualified as completers. Intention-to-treat analyses revealed that the levels of all omega-3 variables were significantly elevated in the omega-3 groups, whereas the placebo group showed little change; there were no between-group differences with overall depression measurements. Per-protocol exploratory analyses showed that scores on the social functioning measurement of the 36-item Short Form Health Survey improved notably in the 400/200 EPA/DHA (p = 0.040) and EPA (p = 0.10) groups compared with the placebo group. Spearman correlation analysis indicated that increased omega-3 indices were associated with improved cognitive depressive symptoms.

    CONCLUSIONS: Omega-3 supplementation resulted in significant increases in omega-3 levels in red blood cell counts, corresponding to a particular compound of omega-3. Changes in cognitive depressive symptoms and social function were in favor of the omega-3 supplementation. Further studies with larger sample sizes are necessary to confirm the benefits of omega-3 supplementation on modifying psychosocial factors for patients with CHF.

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  18. JP Says:

    Updated 09/02/18:

    Epilepsy Behav. 2018 Aug 28;87:32-38.

    The differential effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on seizure frequency in patients with drug-resistant epilepsy – A randomized, double-blind, placebo-controlled trial.

    OBJECTIVES: The omega-3 (n-3) fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are known to play an important role in maintenance and modulation of neuronal functions. There is evidence that omega-3 fatty acids may have anticonvulsant effects. The effect of DHA and EPA on seizure rate in patients with drug-resistant epilepsy (DRE) was investigated.

    METHODS: A double-blind, randomized, placebo-controlled clinical trial included ninety-nine (n = 99) subjects with DRE, aged 5-16 years (n = 85) and 17-45 years (n = 14). After randomization, subjects were given two, four, or six capsules per day of DHA (417.8 mg DHA and 50.8 mg EPA/capsule, n = 33), EPA (385.6 mg EPA and 81.2 mg DHA/capsule, n = 33), or placebo (high oleic acid sunflower oil, n = 33) for one year. The primary endpoint was the effect of treatment on rate of seizure. Random-effects negative binomial regression models were fitted to model the patients’ total count of seizures per month. The treatment effects on seizure incidence rate ratio (IRR) were tested after controlling for the covariate effects of gender, age, rate of seizure per week at enrollment, type of seizure, and number of antiepileptic drug (AED) combinations used at enrollment.

    RESULTS: Fifty-nine subjects (n = 59) completed the study (59.6%). The average number of seizures per month were 9.7 ± 1.2 in the EPA group, 11.7 ± 1.5 in the DHA group, and 16.6 ± 1.5 in the placebo group. Age, gender, and seizure-type adjusted seizure IRRs of the EPA and DHA groups compared with the placebo group were 0.61 (CI = 0.42-0.88, p = 0.008, 42% reduction) and 0.67 (CI = 0.46-1.0, p = 0.04, 39% reduction), respectively. There was no difference in IRR between the EPA and DHA groups (p = 0.56). Both treatment groups had a significantly higher number of seizure-free days compared with the placebo group (p < 0.05).

    SIGNIFICANCE: This study demonstrates that EPA and DHA are effective in reducing seizure frequency in patients with DRE.

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  19. JP Says:

    Updated 10/15/18:

    J Psychiatr Res. 2018 Oct 1;107:48-56.

    Influence of adjuvant omega-3-polyunsaturated fatty acids on depression, sleep, and emotion regulation among outpatients with major depressive disorders – Results from a double-blind, randomized and placebo-controlled clinical trial.

    BACKGROUND: Extant literature shows that adjuvant omega-3-polyunsaturated fatty acids (O3PUFAs) to a standard antidepressant medication impacts favorably on symptoms of depression in participants with major depressive disorders (MDD). The aim of the present study was to investigate, if and to what extent compared to placebo adjuvant O3PUFAs had a favorable impact on symptoms of depression, anxiety, sleep and emotion regulation among outpatients with MDD.

    METHOD: A total of 50 outpatients (mean age: M = 42.46; 68% females) took part in this randomized, double-blind and placebo-controlled study. They were randomly assigned either to the O3PUFA- or to the placebo-condition. Standard medication was sertraline at therapeutic dosages. At baseline, six weeks and 12 weeks later at study completion participants completed questionnaires covering symptoms of depression, anxiety sensitivity, intolerance of uncertainty, sleep disturbances, and emotion regulation. In parallel, experts blind to participants’ group assignment rated participants’ depression with the Montgomery-Asberg Depression Scale.

    RESULTS: Symptoms of depression (self- and experts’ ratings) decreased over time, but more so in the O3PUFA condition, compared to the placebo condition. Likewise, anxiety sensitivity, intolerance of uncertainty and sleep disturbances improved, but again more so in the O3PUFA condition. Further, regulation and control of emotions and perception of other’s emotions improved over time, but more so in the O3PUFA condition.

    CONCLUSIONS: Among outpatients with MDD, and compared to placebo, adjuvant O3PUFAs to a standard medication improved not only symptoms of depression, but also dimensions of anxiety and sleep, and above all patients’ competencies to regulate their emotions.

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  20. JP Says:

    Updated 10/17/18:

    Rep Biochem Mol Biol. 2018 Oct;7(1):59-66.

    The Effect of Omega-3 Fatty Acids on Serum Apelin Levels in Cardiovascular Disease: A Randomized, Double-Blind, Placebo-Controlled Trial.

    Background: Cardiovascular disease (CVD) is the leading cause of mortality worldwide. Omega-3 fatty acids have been shown to have both anti-atherogenic and anti-inflammatory effects through inducing the expression and production of adipokines. Adipokines such as apelin, have been observed to play a protective role in the incidence and progression of CVD. The aim of this study was to assess the influence of omega-3 fatty acids supplementation on the serum apelin levels in patients with cardiovascular disease.

    Methods: Forty-six male patients with CVD participated in the study. Patients were randomly allocated into two groups receiving either omega-3 fatty acids or a placebo. Participants received 4 g of omega-3 fatty acids (EPA: 720 mg, DHA: 480 mg) or a placebo (edible paraffin) for 8 weeks. Serum apelin levels, high sensitive C-reactive protein (hs-CRP), and lipid profiles were measured. Dietary intake, anthropometric parameters, body composition, systolic and diastolic blood pressure were evaluated before and after the 8 weeks of intervention. Statistical analyses were performed using SPSS version 22.

    Results: Two participants from the placebo group withdrew from the study. Prior to the intervention, no significant differences were present between the two groups in age, body mass index, body composition, dietary intakes, lipid profiles and blood pressure. Compared to placebo, the intake of omega-3 fatty acids increased serum apelin levels (p= 0.018), decreased the levels of LDL cholesterol, and decreased serum hs-CRP concentrations (p= 0.007, p= 0.011 respectively). Additionally, the concentrations of VLDL, TG and hs-CRP (p= 0.037, p= 0.037 and p= 0.016 respectively) declined compared to baseline and final values in the omega-3 fatty acids group.

    Conclusion: Omega-3 fatty acid supplementation increases serum apelin and HDL concentrations, while decreasing serum LDL-C and hs-CRP levels.

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  21. JP Says:

    Updated 03/26/19:

    Brain Behav Immun. 2019 Mar 19.

    Omega-3 Polyunsaturated Fatty Acids (n-3 PUFAs) in Cardiovascular Diseases Comorbid Major Depressive Disorder (MDD)- Results from a Randomized Controlled Trial.

    INTRODUCTION: Cardiovascular diseases (CVDs) and major depressive disorder (MDD) will be the two most disabling diseases by 2030. Patients with CVDs comorbid depression had lower levels of total omega-3 polyunsaturated fatty acids (n-3 PUFAs), docosahexaenoic acid (DHA), and a higher omega-6 to omega-3 ratio. However, there have been limited studies on the effects n-3 PUFAs on MDD in patients with CVDs.

    METHOD: We have enrolled a total of 59 patients (64% males, mean age of 61.5 ± 9.0 years and mean education of 10.2 ± 4.2 years) with CVDs comorbid MDD. They were randomized into either receiving n-3 PUFAs (2 grams per day of eicosapentaenoic acid (EPA) and 1 gram of DHA) or placebo for 12 weeks. We assessed depression symptom severity with Hamilton Depression Rating Scale (HAMD) and Beck Depression Inventory (BDI), as well as blood fatty acid levels, electrocardiogram and blood biochemistry, at the baseline and at the endpoint.

    RESULTS: The n-3 PUFAs group had a greater reduction in HAMD Delusion subscale scores than the placebo group at week 8 (p < .05). Moreover, subgroup analyses found that the n-3 group had a greater reduction of HAMD Core subscale scores than the placebo group at week 8 (p < .05) and at week 12 (p < .05) in the patients with severe MDD, but not in those with mild MDD.

    CONCLUSION: N-3 PUFAs supplementation improved core depression symptoms in patients with severe MDD. N-3 PUFAs supplementation may provide a treatment option for patients with CVDs comorbid MDD.

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